title: An evaluation of physicians' engagement of children with asthma in treatment-related discussions.
abstract: Our objectives were to examine whether providers engage children with asthma in treatment-related discussions at the level children prefer (engagement concordance) and to determine whether engagement concordance is related to child, caregiver, and provider characteristics. Children with asthma (n = 296) aged 8-16 years were recruited at five pediatric practices in North Carolina. Using audiotaped medical visit transcripts, we documented the number of treatment-related questions the providers asked the children. Children reported their preferred level of provider engagement. A logistic generalized estimating equation was used to determine which variables predicted engagement concordance. Most children (96.6%) wanted to be involved in treatment-related discussions. One-third of the providers did not ask children any treatment-related questions. Only 36.1% of provider-child dyads were concordant. Most discordant dyads were under-engaged (83.1%). Better engagement concordance was observed among older children (odds ratio (OR) = 1.19, 95% confidence interval (CI) (1.07, 1.33)), male children (OR = 1.67, 95% CI (1.03, 2.70)), and among providers with fewer years in practice (OR = .97, 95% CI (.94, .99)). Providers engaged in treatment-related discussions with younger children and females less frequently than these children preferred. Providers should ask children how much they want to be involved in treatment-related discussions and then attempt to engage children at the level they prefer.
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA dmcarpenter@unc.edu.
authors.forename: Delesha M
authors.initials: DM
authors.lastname: Carpenter
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Stover
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Slota
authors.affiliation: Graduate School of Public Health, San Diego State University, California, USA.
authors.forename: Guadalupe X
authors.initials: GX
authors.lastname: Ayala
authors.affiliation: Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Yeatts
authors.affiliation: Department of Science and Mathematics, Husson University, Maine, USA.
authors.forename: Gail
authors.initials: G
authors.lastname: Tudor
authors.affiliation: School of Medicine, Riley Children's Hospital, Indiana, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Davis
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Williams
authors.affiliation: Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA Cecil G Sheps Center for Health Services Research, North Carolina, USA.
authors.forename: Betsy
authors.initials: B
authors.lastname: Sleath
mesh_terms: D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000628:therapy*; D002648:Child; D002908:Chronic Disease; D003142:Communication; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010358:Patient Participation; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D012737:Sex Factors
keywords: Adolescent; chronic illness; communication; family-centered care; medication